Epidemic Giardiasis at a Ski Resort

Gt, Moore; Wm, Cross; McGuire, Dana Olzenak; Cs, Mollohan; Nn, Gleason; Gr, Healy; Lh, Newton

doi:10.1056/nejm196908212810802

Cited by 178 publications

(32 citation statements)

References 16 publications

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“…We found no evidence of any other gut pathogen in our patients. Malabsorption in giardiasis has been reported from a variety of geographical locations (Amini, 1963;Yardley et al, 1964;Antia et al, 1966;Alp and Hislop, 1969;Moore et al, 1969;Tewari and Tandon, 1974). The comparative paucity of reports probably relates ,to the fact that giardiasis is most common in countries where physicians' time and hospital facilities cannot be expended on the study of an easily treatable gastrointestinal infection.…”

Section: Discussionmentioning

confidence: 99%

“…Giardia lamblia, a flagellate protozoan parasite of the human upper small bowel, is commonly associated with diarrhoea in the tropics (Antia et al, 1966;Ingram et al, 1966;Kapoor and Mody, 1968), though symptomatic giardiasis is reported from temperate areas (Moore et al, 1969;Brodsky et al, 1974;Brady and Wolfe, 1974). The most common symptoms reported are abdominal discomfort, abdominal distension, diarrhoea with soft, offensive, yellow stools, and lassitude.…”

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confidence: 99%

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Giardiasis: clinical and therapeutic aspects.

Wright¹,

Tomkins²,

Ridley³

1977

Gut

122

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SUMMARY Malabsorption was present in 29 of 40 symptomatic patients with giardiasis. Twentythree had impaired D-xylose absorption; in 20 vitamin B12 absorption was low, and 15 patients had steatorrhoea. More severe malabsorption was associated with more marked histological abnormalities. Metronidazole, 2-0 g as a single daily dose on three successive days, produced a parasitological cure rate of 91%. In contrast, the standard course of mepacrine, 100 mg thrice daily for 10 days, eradicated the parasite in only 63% of patients. Improvements in absorption and jejunal morphology followed anti-giardial treatment. Tetracycline in eight patients failed to eradicate the parasite, intestinal absorption was unaltered, and histological appearances of the jejunal mucosa often deteriorated.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Giardiasis: clinical and therapeutic aspects.

Wright¹,

Tomkins²,

Ridley³

1977

Gut

122

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“…It was first described in the late 17th century by the Dutch microscopist Antonie van Leeuwenhoek (62), and research into its epidemiology, pathogenesis, and treatment has intensified since G. lamblia waterborne outbreaks were reported in Europe and the United States during the 1960s and 1970s (53,81,123,128,174). Giardia infects approximately 2% of the adults and 6 to 8% of the children in developed countries worldwide and is currently responsible for the largest number of waterborne outbreaks of diarrhea in the United States (54,139).…”

Section: Introductionmentioning

confidence: 99%

Treatment of Giardiasis

2001

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Giardia lamblia is both the most common intestinal parasite in the United States and a frequent cause of diarrheal illness throughout the world. In spite of its recognition as an important human pathogen, there have been relatively few agents used in therapy. This paper discusses each class of drugs used in treatment, along with their mechanism of action, in vitro and clinical efficacy, and side effects and contraindications. Recommendations are made for the preferred treatment in different clinical situations. The greatest clinical experience is with the nitroimidazole drugs, i.e., metronidazole, tinidazole, and ornidazole, which are highly effective. A 5- to 7-day course of metronidazole can be expected to cure over 90% of individuals, and a single dose of tinidazole or ornidazole will cure a similar number. Quinacrine, which is no longer produced in the United States, has excellent efficacy but may be poorly tolerated, especially in children. Furazolidone is an effective alternative but must be administered four times a day for 7 to 10 days. Paromomycin may be used during early pregnancy, because it is not systematically absorbed, but it is not always effective. Patients who have resistant infection can usually be cured by a prolonged course of treatment with a combination of a nitroimidazole with quinacrine

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“…Giardia lamblia, a protozoan parasite inhabiting the upper small intestine , has been implicated in a number of water-borne epidemics (1) . Infection may remain asymptomatic (2) or lead to an acute or chronic diarrhea with malabsorption (3).…”

Section: Introductionmentioning

confidence: 99%